title: En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature.
abstract: BACKGROUND
  Giant cell tumor (GCT) of distal radius follows a comparatively aggressive behaviour. Wide excision is the management of choice, but this creates a defect at the distal end of radius. The preffered modalities for reconstruction of such a defect include vascularized/non-vascularized bone graft, osteoarticular allografts and custom-made prosthesis. We here present our experience with wide resection and non-vascularised autogenous fibula grafting for GCT of distal radius.
  
  
  METHODS
  Twelve patients with a mean age of 34.7 years (21-43 years) with Campanacci Grade II/III GCT of distal radius were managed with wide excision of tumor and reconstruction with ipsilateral nonvascularised fibula, fixed with small fragment plate to the remnant of the radius. Primary autogenous iliac crest grafting was done at the fibuloradial junction in all the patients.
  
  
  RESULTS
  Mean follow up period was 5.8 years (8.2-3.7 years). Average time for union at fibuloradial junction was 33 weeks (14-69 weeks). Mean grip strength of involved side was 71% (42-86%). The average range of movements were 52° forearm supination, 37° forearm pronation, 42° of wrist palmerflexion and 31° of wrist dorsiflexion with combined movements of 162°. Overall revised musculoskeletal tumor society (MSTS) score averaged 91.38% (76.67-93.33%) with five excellent, four good and three satisfactory results. There were no cases with graft related complications or deep infections, 3 cases with wrist subluxation, 2 cases with non union (which subsequently united with bone grafting) and 1 case of tumor recurrence.
  
  
  CONCLUSIONS
  Although complication rate is high, autogenous non-vascularised fibular autograft reconstruction of distal radius can be considered as a reasonable option after en bloc excision of Grade II/III GCT.
authors.affiliation: Dept of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Raghav
authors.initials: R
authors.lastname: Saini
authors.forename: Kamal
authors.initials: K
authors.lastname: Bali
authors.forename: Vikas
authors.initials: V
authors.lastname: Bachhal
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Mootha
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Dhillon
authors.forename: Shivinder S
authors.initials: SS
authors.lastname: Gill
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D004551:Elbow Joint / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000601:surgery / Q000637:transplantation; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014955:Wrist Joint / Q000502:physiology